New six-year data for a defocus lens by Hoya marks the longest study of a myopia control spectacle lens – and answers key questions about rebounding effects and whether the control effect is sustained over time.
Since the Australian launch of its MiYOSMART defocus spectacle lens in October 2020, Hoya Vision Care believes its innovation has spurred more independent optometrists into myopia management, many offering a proven intervention for the first time.
Anecdotally, optometrists are reporting benefits in prescribing the lens for young children that are yet to adopt a myopia treatment – or have been using less effective spectacle lenses. Others have found it an ideal option for kids not ready for contact lenses, or those that want to discontinue contact lens wear.
Initially, Mr Ulli Hentschel, national training and development manager for Hoya Lens Australia, says the lens found a home with well-established myopia clinics, but the company has seen rapid uptake in practices entering myopia management for the first time. This is particularly the case for practices that may have been reluctant to set themselves up for contact lens interventions.
Hoya’s defocus spectacle lens, developed with The Hong Kong Polytechnic University, incorporates Defocus Incorporated Multiple Segments (D.I.M.S.) Technology that causes a myopia controlling effect, while correcting vision, fitted in a children’s eyeglass frame.
“Providing an intervention that is safe, non-invasive and significantly easier to prescribe – while still offering similar efficacy as other best available interventions – has been a welcome addition to the myopia tool kit for many practices, especially for those who may have only been prescribing single-vision lenses previously,” Hentschel explains, noting that parents are also more familiar with spectacle lens use.
“And in the past six months, we have had many of these optometrists ask how they can take their myopia management to another level, which is why we’ve created other initiatives like partnering with Haag-Streit and Device Technologies to provide a pathway towards optical biometer ownership to measure axial length and provide a gold standard level of myopia management.”
Ease-of-use may be a key feature of the MiYOSMART lens, but optometrists ultimately won’t prescribe it unless there is evidence demonstrating its efficacy.
Last month at the Association for Research in Vision and Ophthalmology (ARVO) 2022 conference in Denver, Colorado, Hoya unveiled the results of a six-year follow-up clinical study on MiYOSMART, shared by Professor Carly Lam from the Centre for Myopia Research at The Hong Kong Polytechnic University who conducted the research.
It marked the longest study on a myopia management spectacle lens, and answered two key questions: is the lens’ myopia control effect sustained over time? And are there any rebound effects after children cease wear?
It built on an original two-year, double-blind randomised trial1, published in the British Journal of Ophthalmology, that concluded children aged 8-13 years wearing MiYOSMART had 60% less myopia progression compared with single-vision wearers as measured by the axial elongation, and a 59% reduction in spherical equivalent refraction.
These findings have been central to Hoya positioning MiYOSMART among the leading interventions. Subsequent three-year data2 showed the lens continued to slow myopia progression, while patients who switched from single-vision to MiYOSMART had a significant slowdown in their condition.
The just-released six-year data at ARVO involved 90 children in Asia. Importantly, Lam reported MiYOSMART’s myopia control effect was sustained over time for wearers. It also confirmed that patients who stopped wearing the lens showed no rebound effects compared to the initial myopia rates of progression during the two-year randomised control trial or with the general population. And the average cumulative myopia progression was less than 1.00 D and axial elongation 0.6 mm over six years in the D.I.M.S. group.3
Hentschel says the results are important for practitioners who can have confidence they’re adopting an approach backed by long-term evidence. It will also help to communicate to parents about the importance of longer-term treatment and what would happen if their child ceased wear.
“How long children need to wear the lens is a common question by parents, and in theory they should until they are in their late teens or an adult when progressions begins to stop naturally,” he says.
“Having six years-worth of data, practitioners can explain to parents that the lens can sustain the myopia control effect over time. And with respect to there being no rebound effect, if a child decides to stop wearing the lens in three to four years for whatever reason, the data shows that won’t be a wasted effort – but the best outcome would be for continuous wear beyond that.”
Hentschel also notes practitioners are seeing results that exceed the average 60% reduction in myopia progression, as reported from the clinical trials. The same trial has shown that myopia progression was stopped in 21.5% of the study population.
“We have had feedback from optometrist customers that have found some children have responded to MiYOSMART extremely well, slowing progression dramatically,” he says.
More than a lens
Hentschel says Hoya is exploring avenues to raise the bar of myopia management beyond MiYOSMART.
An alliance with Haag-Streit and its local distributor Device Technologies Australia, a first-ever direct-to-consumer campaign and the launch of a children’s frame collection are all part of its plan to provide a comprehensive myopia platform so practitioners can address one of the largest public health issues of our era.
Hoya’s global sales and marketing agreement with Haag-Streit/Device Technologies – announced last October – creates a preferred partnership between the entities to offer practitioners “a one-two approach” to myopia. This comes in the form of a diagnostic/monitoring device (Lenstar Myopia optical biometer) and treatment (MiYOSMART).
Ultimately, for practitioners prescribing MiYOSMART, it paves a smoother path towards ownership of a Lenstar Myopia so they can begin adopting axial length measurements in their management, considered a gold standard approach.
The instrument is based on Haag-Streit’s well established Lenstar 900 optical biometer – popular among cataract surgeons – but optimised for myopia management by incorporating specialised software, EyeSuite Myopia.
Hentschel says there has been growing interest in the program, which was explained in detail to delegates at April’s Australian Vision Convention (AVC) in Queensland.
Locally, in an unusual step for a lens company, Hoya is also set to launch an inaugural direct-to-consumer campaign for MiYOSMART, educating parents about the importance of intervention. It will also double as a marketing tool for practices prescribing MiYOSMART.
“Now that we have a critical mass of practices using MiYOSMART, we will soon start a campaign that will feature consumer-focused communications discussing the lens efficacy and raising myopia awareness among parents, including a call to action,” Hentschel explains.
“We will have a dedicated MiYOSMART website parents can visit featuring a ‘practice locator’ to help them find the closest optometrist offering the lens and myopia management.”
Another important component of Hoya’s myopia efforts is to ensure practitioners are prescribing it correctly. That’s why it has partnered with global myopia authorities Dr Kate and Dr Paul Gifford, founders of the Australian-based Myopia Profile platform, to formulate an online accreditation process for MiYOSMART.
Hentschel says it represents one of the first myopia control interventions involving optometrists, as well as optical dispensers.
“It’s important for dispensers to provide an appropriate frame that works well with MiYOSMART, and it’s also vital how they communicate the process to parents and children. Until MiYOSMART came to be, myopia management was predominantly optometry-focused, but now it’s really important the dispensing team and optometrist are across detail,” he says.
Compatible frame selection was also part of the reason for Hoya to launch a new Oliver Wolfe Junior frame collection last November. While not exclusively developed for MiYOSMART, it has been designed with the lens in mind.
Hentschel says the company was frequently asked which frames would work well with MiYOSMART, so the new collection has been a welcome solution. Feedback from local practices has been encouraging, suiting the active care-free lifestyles of children at an affordable price.
“As with our original Oliver Wolfe series, if patients combine it with a Hoya lens, we sell it to the practice at a distributor-level cost, which is great value for the quality you get,” Hentschel says.
“What we are trying to achieve with MiYOSMART extends beyond supplying the lens; from these initiatives you can see it’s about trying to provide a whole platform of myopia management tools and resources that practices need to provide the best possible care.
“Whether it’s in the consulting room with the Lenstar myopia or a therapy that’s working extremely well in MiYOSMART, to the affordable Oliver Wolfe kids frames and communication with consumers, we are trying to raise the level of myopia management in Australia in an accessible way.”
1. Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomized clinical trial. British Journal of Ophthalmology. Published Online First: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739
2. Lam CS, Tang WC, Lee PH, et al. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. British Journal of Ophthalmology Published Online First: 17 March 2021. doi: 10.1136/bjophthalmol-2020-317664
3. Lam CSY, Tang WC, Zhang A, Tse D, To CH. Myopia control in children wearing DIMS spectacle lens: 6 years results. ARVO 2022 Annual Meeting, May 1-4, Denver, US.